DQA Quarterly Information Update
January 2009
PDF Version of this month's Quarterly Update (PDF,
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NEW THIS ISSUE
REGULAR FEATURES
UPCOMING EVENTS
NEW THIS ISSUE
Assisted Living Reaches Historic Milestone
November 19 was an historic day for Assisted Living. On that day, a
registration was issued to a 111-bed RCAC and---for the first
time---Assisted Living beds (CBRFs, RCACs, AFHs) surpassed nursing homes and
FDDs by 96 beds. Assisted Living had 2,853 licensed, certified, and
registered facilities and 38,775 beds compared to NH/FDD with 417 licensed
facilities and 38,679 beds.
Looking back to 1981 when the Nursing Home Moratorium was instituted,
there were approximately 600 NH/FDDs with a capacity of approximately 65,000
beds and approximately 600 CBRFs with approximately 6,000 beds. Twenty-seven
years later, there are approximately 6,500 more beds (when adding AL and NH/FDD
together); however, there has been a seismic shift regarding where people
live.
This shift is indicative of the overall health and strength of the
assisted living industry and the hard work and dedication that has resulted
as the AL community continues the important work of improving the lives of
some of Wisconsin's most vulnerable citizens.
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All Provider Update: Refrigerator Monitoring When Storing
Pharmaceuticals
Many facilities regulated by the Division of Quality Assurance will have
refrigerators of all types that store medications. Some of the medications
must be maintained at specific temperatures and can only be exposed to room
temperatures for short periods of time. If the medications are exposed to
room temperatures for too long the medication may no longer be effective.
For instance, many vaccines can only be exposed to room temperature for a
few hours. In the last year there have been reports across the country of
various vaccines that have been exposed to inappropriate temperatures
leading to re-immunization efforts for thousands of patients.
Providers should review the contents of the medication refrigerator and
develop a procedure for refrigerator monitoring to protect the efficacy of
the medications being stored. Refrigerator temperatures need to be monitored
more often than once a week and may even require daily checks. Thermometers
that continuously monitor temperature and assure that vital vaccines are
maintained appropriately can usually be purchased for less than $100.
If you have questions about pharmaceutical refrigerator monitoring,
please contact:
Doug Englebert
608-266-5388
Douglas.Englebert@dhs.wisconsin.gov
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Emergency Response Education
The State Expert Panel on Long-Term Care Facilities, in collaboration
with the Hospital Preparedness Program of the Wisconsin Division of Public
Health and Lakeshore Technical College, is offering facilities and their
staff unlimited access to a Certificate Course in "Emergency Response
for Healthcare - Basic Level."
Information about the course---course content, subscription fees, CDs,
subscription form, and contact information---can be found at http://gotoltc.edu/em/subscription.php
If you have questions regarding this course or the subscription process,
contact Rich Hoerth, Dean of Public Safety at 920-693-1237 or Lynn Senovich
at 920-693-1106.
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Improved Communication with Non-Long Term Care Providers
Hospitals, Home Health Agencies, Hospices, ESRDs, Rural Health
Clinics, Outpatient Rehabilitation Facilities, ASCs, CORFs
Effective with 2009 surveys, the Bureau of Health Services will offer an
improved method of documenting the results of a verification visit. DQA will
no longer mail a letter or copies of the computer generated CMS 2567B form
following our visit. If a provider wants paper documentation of the outcome
of the verification visit, they can e-mail the Bureau and request a provider
profile report. The Bureau will answer the e-mail with an attached file
containing the profile, which reflects all surveys and their status. To
submit your request, contact Sandy Jencen at Sandra.Jencen@dhs.wisconsin.gov
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MDS and OASIS Recipient Medicaid Numbers
All Medicaid beneficiaries enrolled in Wisconsin Medicaid will soon
receive a ForwardHealth Card with a newly-assigned 10-digit member
identification number. This randomly-assigned "member number"
replaces the previous 10-digit number based on an individual's Social
Security Number and will provide greater security for Medicaid
beneficiaries' identities and their protected health information.
Nursing homes and home health agencies should enter these new member
numbers for their Medicaid clients at the time their next MDS or OASIS
assessment is completed. When these records are submitted to the State
MDS/OASIS System the Final Validation report will list warning message - 81,
indicating that resident/patient information has been updated. Providers
should verify that the number that follows "New" is the correct
member number for this person.
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MDS and OASIS Broadband Connection Required
All nursing homes and home health agencies must use a broadband (cable/dsl)
connection for MDS and OASIS assessment submissions. On February 1, 2009,
CMS will discontinue access through dial-up.
Updated information, including a new broadband solution for providers
that were having difficulty converting to broadband, has been posted at https://www.qtso.com
Select the MDCN Information link in the blue outlined box on the right
hand side of the page. The AT&T Global Client software version 7.2.1 and
detailed set up instructions are available.
If you are using a network, a revised network document is available for
download. Please forward this information to your network administrators.
They will need the port information to ensure a successful connection.
Please do not wait until the last minute to set up your broadband
connection. Technical support for your efforts is available at
MDCN Help Desk
800-905-2069 (Choose option 2 for technical support.)
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New Revision of OASIS-C
CMS released the newest revision of OASIS-C for Home Health agencies on
November 14, 2008. OASIS-C is expected to replace the current version of
OASIS, effective January 1, 2010. Field testing of the instrument is
complete, and CMS is publishing OASIS-C for the 'final public comment'
period, ending 1/13/09. This new revision, dated 11-11-08, can be viewed at http://www.cms.hhs.gov/HomeHealthQualityInits/
Information related to submitting comments to CMS is available in the
Federal Register article published November 14, 2008, and is available at
http://occb.affiniscape.com/associations/3264/files/E8-27060_fed_reg_11_14_08.pdf
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Office of Caregiver Quality (OCQ) Updates
Receiving Results of the Nurse Aide Examination
Nurse aide candidates receive the results of their National Nurse Aide
Assessment Program (NNAAP) examination by one of two methods---via fax or
mail. The quickest and most common way to receive these results is via fax
at the test site shortly after the evaluator has faxed the completed
examination score sheet to Pearson Vue. Should the candidate not want to
wait for the faxback results, the results will be mailed to the candidate
from Pearson Vue.
If the fax system is not working, the score sheets must be hand scored at
Pearson Vue in Philadelphia. The evaluator sends all the score sheets to
Pearson Vue via FedEx the next business day after the test date. Pearson Vue
has ten business days from the day Pearson Vue receives the score sheets to
hand score them and mail the results out to the candidate. Test results can
not be given over the telephone.
After the test is hand scored, the results (fail or pass) are mailed out
to the candidate at the address listed on the candidate's test application.
Note: It takes about four or five days for mail correspondence to get from
Philadelphia to Wisconsin.
- If the candidate passes the examination, the candidate is placed on
the Wisconsin Nurse Aide Registry and a Registry card is mailed to the
candidate.
- If the candidate fails the examination, the score report provides the
candidate with the information needed to reapply and to take the part or
parts of the exam that have been failed.
The nurse aide candidate should contact Pearson Vue at 1-877-329-8760 if
their name does not appear on the Wisconsin Nurse Aide Registry within 15
business days after having taken the NNAAP examination or if they have not
received their test results after 20 business days. The candidate must
provide Pearson Vue with the information that will assist Pearson Vue with
its research---test site, test date, and the name of the evaluator, if
possible. For more information, see the Wisconsin Nurse Aide Candidate
Handbook at
http://www.asisvcs.com/publications/pdf/075000.pdf
DQA Regulated Entity Background Check Process
If an entity wishes their license approval to continue, the license
holder or legal representative must submit the completed forms for the
required four-year renewal process regardless of when a DQA regulated entity
last submitted an application for licensure, certification, or registration,
Some license holders/legal representatives have still not complied with
the requirements as stated in DQA Memo 08-015. If you have not submitted the
necessary paperwork, access the Department's web page at:
http://www.dhs.wisconsin.gov/caregiver/entity-cbc.htm
to obtain the necessary forms for the Existing License Holder Four-Year
Renewal Background Check Process. Providers who have failed to comply will
be cited in 2009.
If you have questions regarding this matter, contact
DQA Office of Caregiver Quality
(608) 261-8319 Telephone
(608) 264-6340 FAX
DHSCaregiverIntake@wisconsin.gov
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REGULAR FEATURES
Changes in DQA Staff
Mary Eckwright, Nurse Consultant, Joins BAL WRO Survey Team
Mary Eckwright, Nurse Consultant, will be joining the Bureau of Assisted
Living's Western Regional Office survey team on January 4, 2009. Mary is
transferring from the Bureau of Nursing Home Resident Care, where she has
been a nursing home surveyor for five years. Mary is a registered nurse with
a bachelor's degree from the University of Wisconsin in Eau Claire. She
previously worked at Northern Wisconsin Center as a QMRP and as a nursing
supervisor and at Lutheran Social Services in the development of group homes
and the supervision of their personal care worker program.
Tracy Moraine, Medical Technologist, Joins CLIA
The Division of Quality Assurance welcomes its new CLIA surveyor, Tracy
Moraine. Tracy has a Bachelor of Science degree in Medical Technology with
over 25 years of experience as a Medical Technologist. Tracy has worked in
various hospitals, clinics, and independent laboratories in the role of
manager, Medical Technologist, coordinator, and supervisor. Tracy was also
an instructor at UW-Milwaukee.
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DQA Numbered Memos (October, November, December)
Access these memos via:
http://www.dhs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm
or via individual providers' publications pages at
http://www.dhs.wisconsin.gov/rl_DSL
DQA Memos
|
Memo No. |
Title |
Summary |
Providers Affected |
| 08-025 |
Guidelines for
Managing
(Methicillin-Resistant
Staphylococcus Aureus) MRSA |
This memo provides guidance for managing MRSA when
present in residents of assisted living facilities and will
specifically address MRSA as the most commonly encountered
multidrug-resistant organism in assisted living facilities. |
Adult Family Homes
Community-Based Residential Facilities
Residential Care Apartment Complexes
|
| 08-026 |
Changes to
Wisconsin
Administrative
Code Chapter HFS
129 |
This memo provides feeding assistant, medication aide,
and nurse aide training programs with information on the changes to
Chapter HFS 129 and notifies them of the June 30, 2009 implementation
deadline. |
Medication Aide Training Programs
Nurse Aide Training Programs
Nursing Homes |
| 08-027 |
Change in the
Statement of
Deficiency (SOD)
Numbering
System |
DQA has recently implemented a new database, the ASPEN
Licensing Information System (ALIS), to replace its former Facility
Licensing and Certification Information System (FL/CIS). This
memo serves as notification and explanation of the change in the SOD
numbering system effective January 1, 2009. |
Facilities for the Developmentally Disabled
Home Health Agencies
Hospices
Hospitals
Nurse Aide Training Programs
Nursing Homes
Rural Health Clinics
Certified Mental Health and AODA
Ambulatory Surgery Centers
End Stage Renal Dialysis Units
Outpatient Rehabilitation Facilities |
| 08-028 |
Wisconsin Administrative Code Chapter HFS 131 Variances |
This memo addresses three areas of Wisconsin
Administrative Code Chapter HFS 131 that require variances in order to
be consistent with the Federal Conditions of Participation (CoP) for
Hospices |
Hospices |
| 08-029 |
Revisions to
Wisconsin State
Statutes, Chapter
50, and
Chapter HFS 12, Wisconsin
Administrative
Code |
Wisconsin Act 172 was signed into law on March 26,
2008. Newly created section 50.065 (2m), effective November 1,
2008, requires entities to disclose certain information regarding a
caregiver who is assigned to provide personal care services in a
client's residence.
The new law also requires DHS to specify, by rule, crimes for which
an entity must disclose a conviction of its caregivers who are
assigned to provide personal care services. |
Home Health Agencies
Hospices |
| 08-030 |
Implementation of
Wisconsin
Administrative
Code DHS 129 |
DQA Memo 08-026 announced the legislature's approval of
the revisions to Chapter DHS 129. The purpose of this memo is to
provide direction and guidance regarding the actual implementation of
the changes that affect the training of nurse aides as of December 1,
2008. |
Nurse Aide Training Programs |
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HFS Administrative Rules Update
HFS 12 - Caregiver Background Checks
On September 15, 2008, the Wisconsin Administrative Rules website
published the Initial Proposed Rulemaking Order including a summary and text
of the proposed rule, Wisconsin Administrative Code, Chapter HFS 12. Section
50.065 (2m) (d) requires the Department to promulgate rules to specify
crimes for which an entity must disclose to a client or the client's
guardian, a conviction of a caregiver who is assigned to provide personal
care services to the client in the client's personal residence and to
specify who is a "substitute caregiver." The proposed rule was
revised based upon comments received from advocacy organizations, trade and
professional associations, and other interested parties.
A public hearing for the rule was held on January 6, 2009 in Madison.
Written comments regarding the proposed rule will be accepted until January
13, 2009.
For more information, you may view the proposed rule and public hearing
notice on the Wisconsin Administrative Rules website at https://health.wisconsin.gov/admrules/public/Home
HFS 83 - Community Based Residential Facilities
On November 25, 2008, the Wisconsin Administrative Rules website
published the Final Rulemaking Order including a summary and text of the
proposed rule, Wisconsin Administrative Code, Chapter HFS 83. The goal of
the proposed rule is to focus on resident outcomes and quality of life and
quality of care, improve readability and organization, eliminate excess and
prescriptive language, revise staff training standards establishing a more
cost effective system for providers, and promote the use of nationally
recognized standards of practice.
The rule is expected to become effective April 1, 2009. For more
information, you may view the final rule on the Wisconsin Administrative
Rules website at https://health.wisconsin.gov/admrules/public/Home
HFS 85 - Non-Profit Corporation as Guardian
On September 19, 2006, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter HFS 85, Non-profit
Corporation as Guardian. Through this initiative, the Department proposes to
make the rule reflect current standards of practice, recognizing the
increase in the number of adults in need of guardianship and the increase in
the complexity of their needs.
An Advisory Committee, including advocates, providers, registers in
probate, and County adult protective services staff met and reviewed
proposed rule language and made recommendations for change. The Department
revised the proposed rule based upon comments from the Advisory Committee.
The proposed Rule Order is currently under review by the DHS Office of Legal
Counsel. For more information, you may view the Statement of Scope on the
Wisconsin Administrative Rules website at https://health.wisconsin.gov/admrules/public/Home
HFS 124 - Hospitals
On April 1, 2005, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter 124. The Department is
planning to update Chapter HFS 124 to eliminate overly prescriptive and
outdated regulations, clarify the Department's enforcement authority, and
make the rule more consistent with the federal Medicare requirements.
The Department asked representatives from a large number of trade and
professional associations, hospitals, and other interested parties, to
review proposed revisions to the rule and make recommendations for change.
The Department is reviewing their recommendations and preparing a revised
draft of ch. HFS 124 for further review by stakeholders. For more
information, you may view the Statement of Scope on the Wisconsin
Administrative Rules website at https://health.wisconsin.gov/admrules/public/Home
DHS 129 - Certification Programs for Training and Testing Nurse
Aides, Home Health Aides, and Hospice Aides
On December 1, 2008, revisions to Chapter DHS 129 went into effect. The
revised rule includes training and testing requirements of feeding
assistants and medications aides, reflects the standardization of the
administration and operation of nurse aide competency evaluation by a
contracted agency, improves the accuracy and integrity of the nurse aide
registry, and expands the mechanisms available for enforcing compliance of
training and testing programs. For more information, you may view the rule
at http://www.legis.state.wi.us/rsb/code/dhs/dhs129.pdf
DQA Memos 08-026 and 08-030 provide important information about the
implementation of the revised rule and can be found at http://www.dhs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm
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CMS Survey & Certification Letters (October,
November, December)
Listed below are Survey and Certification (S&C) Letters distributed
by CMS during the last quarter. Please note that the CMS Internet site where
you can review all S&C memos is http://www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/list.asp
Survey and Certification Letters
|
S&C No. |
Title |
Summary |
Providers Affected |
| 09-01 |
Advance Copy ESRD Program Interpretive
Guidance Version 1.1 |
This memo includes an advance copy of the
ESRD Interpretive Guidance |
End Stage Renal Dialysis Units |
| 09-02 |
Approval of Deeming Authority of Det
Norske Veritas Healthcare, Inc. for Hospitals |
This memorandum announces the CMS
decision to approve Det Norske Veritas Healthcare, Inc. (DNV
Healthcare) for recognition as a national accreditation program for
hospitals seeking to participate in the Medicare program. |
Hospitals |
| 09-03 |
Enforcement of Section 506, MMA,
Acceptance of Medicare-like Rates |
Section 506 of the MMA requires hospitals
and critical access hospitals (CAHs) to accept Medicare-like rates
when providing care to individuals who are beneficiaries of Indian
Health Service (IHS), Tribal health, and urban Indian health programs.
42 CFR 489.29 implements the statutory requirement. |
Hospitals
Critical Access Hospitals |
| 09-04 |
Adoption of New Fire Safety Requirements
for LTC, Mandatory Sprinkler Installation Requirement |
The purpose of this memorandum is to
notify States and regional offices of the publication on August 13,
2008, in the Federal Register (73 FR 47075), of a final rule entitled,
"Medicare and Medicaid Programs; Fire Safety Requirements for
Long Term Care Facilities, Automatic Sprinkler Systems," with an
effective date of October 14, 2008. |
Long Term Care Facilities |
| 09-05 |
Special Focus Facility (SFF) Program
Survey Scoring Methodology |
This memorandum provides specific
details on the scoring methodology used to identify those nursing
homes that become candidates for the SFF initiative by virtue of their
more serious history of severe and persistent quality of care
problems. We explain the method for scoring nursing home deficiency
findings and survey results. The SFF methodology produces a score for
identifying those facilities that merit closer survey attention
through the SFF initiative. |
Nursing Homes |
| 09-06 |
Revised CLIA Policy on Quality Control for
Commercially Available Microbial Identification Systems |
This memorandum revises the analytic
system information for microbial information systems found in CMS
Interpretive Guidelines (IG) for Laboratories and Laboratory
Surveyors. |
CLIA Certified Laboratories |
| 09-07 |
New Web Feature: Laboratories Demographic
Look-Up |
This letter announces the introduction of
the CLIA Laboratory Demographics Look-up link on the CMS CLIA Web
site. The CLIA Laboratories Demographic Look-up link leads to
demographic information about CLIA certified laboratories. |
CLIA Certified Laboratories |
| 09-08 |
Accreditation and its Impact on Various
Survey and Certification Scenarios |
CMS has developed a comprehensive
set of FAQs and responses related to the impact of a provider /
supplier's accreditation status on various survey and certification
activities. Although much of this guidance may be found in various
sections of the SOM or in previous S&C policy memoranda, the FAQs
make this information available in one document. |
All Accredited Providers / Suppliers |
| 09-09 |
Advance Copy - Organ Transplant Program
State Operations Manual (SOM) and Survey Protocol |
Included in the memo is an advance copy of
changes to Chapters 2 and 3 of the SOM and the Survey Protocol which
will be included in Appendix X of the SOM. |
Organ Transplant Programs |
| 09-10 |
Standing Orders in Hospitals Revisions to
S&C Memoranda |
CMS is clarifying a portion of
S&C-08-12 and S&C-08-18, issued on February 8 and April 11,
2008 respectively, regarding use of standing orders in hospitals. |
Hospitals |
| 09-11 |
Release of Report - Freedom from
Unnecessary Physical Restraints: Two Decades of National Progress |
This report evaluates the efforts to
reduce the use of physical restraints after Congressional Passage of
the 1987 Nursing Home Reform Act. |
Nursing Homes |
| 09-12 |
SOM Chapter 5 Update - Release of
Person-Identifiable Data Related to Restraint/Seclusion Deaths |
S&C-08-23, issued May 30, 2008,
updated Section 5140 of the SOM, concerning handling of hospital
reports of deaths associated with the use of restraint or seclusion. |
Hospitals |
| 09-13 |
Waivers and Phase-In Time Extensions for
the Implementation of the New ESRD Conditions for Coverage |
While the overall effective date for
implementing new or revised ESRD Conditions for Coverage was October
14, 2008, the rule specifies separate effective dates for certain
Conditions and provides that some facilities may request a waiver for
certain other requirements. In this memorandum we describe the
procedures CMS is implementing for requesting a waiver or time-limited
extension of the time needed to phase-in the program improvements
needed to achieve full compliance. |
End-Stage Renal Dialysis Units |
| 09-14 |
Interim Guidance Regarding the Survey and
Certification of RHCs and FQHCs |
The regulations at 42 CFR Part 405,
Subpart X, Section 2401 and 42 CFR Part 491, Subpart A, governing RHC
and FQHC participation in Medicare, have undergone major changes in
recent years and are now proposed for further changes. This memorandum
provides an overview of previous changes and clarifies the current RHC
and FQHC regulatory requirements. |
Rural Health Clinics
Federally Qualified Health Centers |
| 09-15 |
New CAH requirements under 42 CFR
485.610(e) related to CAH Co-location and provider-based locations |
CMS published a final rule in the November
27, 2007 Federal Register (72 Fed. Reg. 66934) amending 42 CFR Part
485 Subpart F, adding a new standard at 485.610(e), governing a CAH's
location relative to other hospitals or CAHs with respect to
co-location and off-campus provider-based arrangements. These
amendments became effective January 1, 2008 |
Critical Access Hospitals |
| 09-16 |
Additional Revision of SOM -
Federally Qualified Health Centers (FQHCs) |
Sections 2003A and 2826 of the SOM are
being revised to clarify the effective date for FQHC supplier
agreements and to update information on the Medicare Administrative
Contractor (MAC) and legacy Fiscal Intermediary (FI) assignments for
tribal and Urban Indian FQHCs. |
Federally Qualified Health Centers |
| 09-17 |
Launching of Five Star Rating System on
the Nursing Home Compare Website |
The purpose of this memorandum is to give
the State Survey Agencies advance notice of the Five Star Quality
Rating System being added to the Nursing Home Compare Web site. States
will receive a preview of their provider's Five-Star rating on
December 15, 2008. Providers will have access to their individual
Five-Star rating beginning December 16, 2008. |
Nursing Homes |
| 09-18 |
The Five Star Nursing Home Rating System
-Questions and Answers |
The Five Star Nursing Home Rating System
was launched on December 18, 2008, to give consumers a more user
friendly way to compare nursing homes within a State. This memo
provides a comprehensive set of questions and answers concerning the
Five Star Rating System. |
Nursing Homes |
Content contact: Gina
Bertolini
Phone: (608) 266-6691
E-MAIL SUBSCRIPTION SERVICES
http://www.dhs.wisconsin.gov/rl_DSL/Listserv/signup.HTM
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Last Updated:
March 26, 2013
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